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. 2018 Nov;10(11):6020-6029.
doi: 10.21037/jtd.2018.10.36.

Patient and procedural features predicting early and mid-term outcome after radical surgery for non-small cell lung cancer

Christoph Ellenberger  1 , Najia Garofano  1 , Thomas Reynaud  1 , Frédéric Triponez  2 , John Diaper  1 , Pierre-Olivier Bridevaux  3 , Wolfram Karenovics  2 , Marc Licker  1
Affiliations

Patient and procedural features predicting early and mid-term outcome after radical surgery for non-small cell lung cancer

Christoph Ellenberger et al. J Thorac Dis. 2018 Nov.

Abstract

Background: Postoperative cardiovascular and pulmonary complications (PCVCs and PPCs) are frequent and result in prolonged hospital stay. The aim of this study was to update the risk factors associated with major complications and survival after lung cancer surgery.

Methods: This is a post-hoc analysis of a randomized controlled trial that was designed to assess the benefits of preoperative physical training. After enrollment, clinical, biological and functional data as well as intraoperative details were collected. In-hospital PCVCs and PPCs were recorded and survival data were adjudicated up to 4 years after surgery.

Results: Data from 151 patients were analyzed. Thirty-day mortality rate was 2.6% and the incidence of PCVCs and PPCs was 15% and 33%, respectively. Stepwise logistic regression analysis showed that, PCVCs were mainly related to elevated plasma levels of brain natriuretic peptides [odds ratios (ORs) =6.0; 95% confidence interval (CI), 1.3-27.3] and performance of a pneumonectomy (OR =9.6; 95% CI, 2.9-31.5) whereas PPCs were associated with the presence of COPD (OR =5.9; 95% CI, 2.4-14.8), current smoking (OR =2.6; 95% CI, 1.1-6.5) and the need for blood transfusion (OR =5.2; 95% CI, 1.2-23.3). Preoperative physical training was a protective factor regarding PPCs (OR =0.13; 95% CI, 0.05-0.34). Cox proportional hazards regression analysis showed that ventilatory inefficiency during exercise (expressed by a ratio >40 of ventilation to carbon dioxide elimination), coronary artery disease, elevated plasma levels of brain natriuretic peptides and the occurrence of PPCs were all predictive of poor survival after surgery.

Conclusions: Besides smoking and the extent of lung resection, preexisting cardiopulmonary disease as evidence by elevated levels of brain natriuretic peptides and inefficient ventilation are associated with poor clinical outcome after lung cancer surgery.

Keywords: Postoperative pulmonary complications; lung cancer surgery; mid-term survival; postoperative cardiovascular complications.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Kaplan-Meier survival curves after lung cancer surgery and log-rank test for differences in survival according to the presence of coronary artery disease, elevated plasma levels of cardiac biomarkers (NT-pro-BNP <100 pg/mL), ventilatory inefficiency (VE/VCO2 >40) and the occurrence of postoperative pulmonary complications.
See this image and copyright information in PMC

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